Healthcare Provider Details

I. General information

NPI: 1255066528
Provider Name (Legal Business Name): KAITLIN CHRISTINA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12580 LAKELAND RD
SANTA FE SPRINGS CA
90670-3940
US

IV. Provider business mailing address

12580 LAKELAND RD
SANTA FE SPRINGS CA
90670-3940
US

V. Phone/Fax

Practice location:
  • Phone: 562-210-5751
  • Fax:
Mailing address:
  • Phone: 562-210-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW132068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: